Provider Demographics
NPI:1235299967
Name:VANHECKE, DEBORAH P (ST)
Entity Type:Individual
Prefix:
First Name:DEBORAH
Middle Name:P
Last Name:VANHECKE
Suffix:
Gender:F
Credentials:ST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:871 DON CUBERO AVE
Mailing Address - Street 2:
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87505
Mailing Address - Country:US
Mailing Address - Phone:505-989-9635
Mailing Address - Fax:505-424-9777
Practice Address - Street 1:8 CALLE MEDICO
Practice Address - Street 2:
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87505
Practice Address - Country:US
Practice Address - Phone:505-424-8777
Practice Address - Fax:505-424-9777
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-11
Last Update Date:2011-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM491235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
10014142OtherLOVELACE
NM23931281Medicaid
PROVP16732OtherMOLINA
810849380OtherPHCS
2413411OtherUHC
NMNM00E226OtherBCBS NM